Adolescence is an important window of opportunity to improve nutrition and establish healthy behaviours that can continue into adulthood. However, adolescents in India and Nepal face multiple nutritional challenges, including undernutrition and micronutrient deficiencies alongside increasing overweight and obesity. Rapidly changing food environments and increasing availability and promotion of unhealthy foods and beverages add to these challenges.

We aim to co-create and evaluate a comprehensive school-based nutrition intervention that addresses both adolescents' dietary behaviours and the food environments that shape their choices.
The project follows a systematic pathway from understanding the context and identifying needs, to co-creating solutions with stakeholders, and then simultaneously evaluating intervention effectiveness and implementation through a Hybrid Type II effectiveness–implementation trial, alongside an economic evaluation.

Understanding the context (Work Package 1)

We will first conduct a desk review and formative study in India and Nepal to understand adolescent nutrition, dietary behaviours and the environments in which food choices are made. The desk review will synthesize existing evidence, policies, programmes and recommendations relevant to adolescent nutrition and school food environments. The formative study will generate context-specific evidence on adolescents' dietary behaviours and the individual and environmental factors influencing these behaviours.

Co-creating the intervention (Work Package 2)

Building on findings from the desk review and formative study, we will co-create the intervention with adolescents and key stakeholders (adolescents, parents, teachers, school leaders) in India and Nepal, separately. The resulting multicomponent intervention will address both adolescent behaviours and the school food environment, combining nutrition and behaviour-change activities with strategies to make healthier choices more available, accessible and acceptable within schools in India and Nepal.

Evaluating effectiveness and implementation (Work Packages 3 and 4)

The co-created intervention will be evaluated using a Hybrid Type II effectiveness–implementation cluster-randomized controlled trial in schools in India and Nepal. This design places dual emphasis on intervention effectiveness and implementation, allowing us to determine whether the intervention improves adolescent nutrition while simultaneously examining how it can be successfully delivered in real-world school settings.
The effectiveness evaluation will assess changes in adolescents' nutritional status and dietary behaviours, with healthy weight status at 12 months as the primary outcome, alongside secondary outcomes related to diet behaviours, nutritional status, physical activity, and oral health and mental well-being. We collaborated with our trial statistical experts at the University of Birmingham, UK. 

The implementation evaluation will examine reach, adoption, acceptability, feasibility, fidelity, and sustainability using a REACH framework, as well as contextual barriers and facilitators influencing implementation. This will help us understand not only whether the intervention works, but also how and why it works, for whom, and under what circumstances.

Assessing economic value (Work Package 5)

Alongside the Hybrid Type II trial, we will conduct an economic evaluation to assess the resources and costs associated with delivering the intervention and its value relative to the outcomes achieved.
Combining evidence on effectiveness, implementation and economic value will provide a stronger basis for decisions about sustainability and potential scale-up.

As part of this main project, we won additional funding to collaborate with researchers from Ukraine (project number: 361665), who were recruited through the Research Council of Norway’s “Recruit a Researcher from Ukraine for an Ongoing Researcher Project”, to conduct systematic reviews and meta-analyses on topics relevant to informing and guiding the activities of Work Packages 2, 3, 4.